Treating percutaneous coronary intervention-related myocardial injury with metformin.

PCI [1] , which underscores the need to monitor patients post-PCI and to develop therapeutic strategies to combat PMI. The assessment of circulating biomarkers such as troponin I or T and creatine kinase-MB (CK-MB) following PCI has become an important clinical tool for the identification of patients at risk for the development of PMI [1, 3, 4] . For example, a rise in circulating CK-MB levels to 5 times the upper limit of normal likely represents a substantial myocardial infarction associated with PMI [4] . In terms of treatment, aspirin [6] , clopidogrel [7] , and statins [8] have been shown to reduce the incidence of PMI when administered to patients before PCI. In the current issue of Cardiology , Li et al. [9] demonstrate that metformin also has beneficial effects in reducing the incidence of PMI following PCI. In this prospective, open, randomized clinical study, the authors enrolled 152 metabolic syndrome patients scheduled for elective coronary intervention. Importantly, these patients did not have a prior history of metformin treatment. Starting 1 week before the PCI, the patients were randomized into a placebo (n = 76) and a metformin (250 mg t.i.d.) treatment group (n = 76). To evaluate the incidence and severity of PMI, CK-MB and troponin I levels were measured at baseline and then at 8 and 24 h after the procedure. Clinical outcomes were also monitored for 1 year. Metformin pretreatment was found to reduce post-PCI elevations in Coronary artery disease (CAD) resulting from the build-up of plaque in the arteries of the heart remains a leading cause of morbidity and mortality throughout the world. In clinical practices, percutaneous coronary intervention (PCI) has become the standard, nonsurgical revascularization procedure for opening blocked arteries in patients with CAD [1] . Substantial advances in the technology behind PCI coupled with its routine use have made this procedure relatively safe. As such, PCI plays a central role in the management of patients with both stable and unstable CAD. However, despite the purported safety of PCI, 5–30% of patients undergoing this procedure experience postprocedure or periprocedural myocardial injury (PMI) [2, 3] . At the upper end of this range, the occurrence of myocardial events is similar to the annual rate of major spontaneous myocardial infarction [4] , making PMI a serious clinical complication. PMI generally is a result of procedural complications such as distal embolization, side-branch occlusion, coronary dissection, or disruption of collateral blood flow [1] . The occurrence of these complications is associated with risk factors related to the individual patient or the type of coronary lesion [2, 4] . For instance, patient-related factors such as advanced age, diabetes, renal failure, multivessel disease, and left ventricular dysfunction are important determinants of clinical outcomes following PCI [5] . Importantly, PMI also occurs silently after an uneventful Received: October 18, 2013 Accepted: October 21, 2013 Published online: December 5, 2013